One More Reason to Take That Weight Off!

Obesity limits a patient's range of motion (ROM), prolongs recovery and extends the need for physical therapy after total knee replacement surgery, according to a study presented today by Geoffrey Westrich, MD, of Hospital for Special Surgery at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons.

The study found that a patient's body mass index (BMI) had a direct correlation on the knee's ROM and the need for manipulation under anesthesia. Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. While fewer than 10 percent of patients with a BMI of less than 25 required manipulation in physical therapy to achieve greater flexibility and break up scar tissue, almost 20 percent of patients with a BMI of 25-30 required manipulation.

According to the National Institutes of Health, people with a BMI of 25 - 29.9 are considered overweight and a BMI of 30 or greater would indicate obesity.

"For anyone considering knee replacement surgery, recovery time is an important consideration. Patients ask 'Is my pain going to be relieved? Will I have better range of motion?'" said Dr. Westrich, lead author and associate professor of orthopedic surgery at Hospital for Special Surgery in New York City. "Our findings will help set more realistic expectations for overweight patients. They need to be counseled that their weight will likely impede their recovery."

The study compared data from 309 patients (400 knee replacements) who underwent total knee replacement surgery at Hospital for Special Surgery. Researchers evaluated the affect of BMI on ROM and the need for manipulation under anesthesia. Patients were divided into groups according to their BMI, from less than 25 to greater than 29.9.

Other significant findings in the study include:

The greater a patient's BMI, the less ROM they can expect after knee surgery;

Age was not a predictor for ROM;

Gender is a predictor for ROM and need for manipulation. Regardless of BMI, men had a 4.6 degree higher ROM than women. Less than 10 percent of men needed manipulation six weeks after surgery, compared to 18.5 percent for women.

"Our study reinforces the drain that obesity is having on the healthcare system," said Dr. Westrich. "The obesity epidemic is causing healthcare expenditures to grow at a rapid rate. Insurance companies, Medicare, hospital administrators, and patients need to understand that obesity will likely cause different patient outcomes, including more complications which may require further surgical interventions." Also Dr. Westrich concludes that "setting realistic expectations prior to surgery is paramount to patient care."

Most patients who undergo total knee replacement are between 60 and 80 years old, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient's pain and disability, not age. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis. Surgeons performed more than 533,000 knee replacements in 2005.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.